Provider Demographics
NPI:1215592670
Name:UNION SQUARE MEDICAL PRACTICE PC
Entity Type:Organization
Organization Name:UNION SQUARE MEDICAL PRACTICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-829-1392
Mailing Address - Street 1:121 W 27TH ST STE 504
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-6207
Mailing Address - Country:US
Mailing Address - Phone:646-351-0911
Mailing Address - Fax:516-210-0225
Practice Address - Street 1:55 W 17TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-5513
Practice Address - Country:US
Practice Address - Phone:212-427-8761
Practice Address - Fax:212-427-8762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-01
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty